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研究生:陳雅雯
研究生(外文):Chen, Ya-Wen
論文名稱:醫師執業地點、執業機構型態之選擇及其影響因素探討-以家醫科醫師之專業生涯選擇為例
論文名稱(外文):Factors influencing physician choices of practice location and institution: A case study on professional career choices of family medicine specialty physicians
指導教授:曾旭民曾旭民引用關係
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
論文頁數:143
中文關鍵詞:執業地點執業機構型態專業生涯選擇家庭醫學
外文關鍵詞:practice locationpractice institutionprofessional career choicesfamily medicine
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近十年來,醫師執業地點之分布除了在地理位置上出現分布不均外,在執業機構層級別間的分布亦有向都市地區的大型醫院集中的趨勢。然而,全民健保實施後,醫師地理位置的分布均衡與否,乃是影響民眾就醫可近性能否確保的關鍵因素之一。因此,本研究之目的乃嘗試分析個人背景特質、習醫過程經驗、個人的價值觀取向及認知考量態度,與醫師目前執業地點、執業機構型態間的關係,並進一步探討影響醫師選擇執業地點、執業機構型態之因素。
本研究以畢業八年以上、非公費醫師身份的家庭醫學科醫師做為探討的對象,醫師名單由台灣家庭醫學醫學會會員名冊中取得,共計有743位家醫科醫師納入本研究之中。研究方法採郵寄問卷的方式以收集相關的研究資料,問卷回收結果有21.3%的回收率,有效問卷為130份。
經對數迴歸分析結果顯示,(1)成長家鄉在都市地區、畢業10年以下、住院醫師受訓地點在都市地區、越重視家人需求的醫師,較相對特性者傾向在都市地區執業。(2)畢業10年以上、在地區醫師受訓之醫師,較相對特性者傾向自行(或合夥)開業。(3)越重視對執業地點熟識度的醫師,越傾向回到家鄉執業。(4)畢業10年以下、較重視專業學習與研究及對醫院熟悉度之醫師,較相對特性者傾向在原受訓醫院中執業。(7)醫師選擇執業地點時,主要以與經濟有關的因素為主要考量,其次為子女的教育資源。(8)醫師選擇執業機構型態時,主要以工作負荷量及醫院聲望與整體環境為主要考量,其次為醫療技術及知識的獲得。
綜合研究之結果可發現,除了「畢業年限」是影響醫師執業地點及執業機構型態選擇的主要因素之外,「住院醫師期間的受訓經驗」對於其未來專業生涯之選擇最具影響作用。因此建議在可透過安排剛畢業的醫師到醫療資源較不足的地區或醫療機構中接受住院醫師訓練,以增加醫師於完成訓練後繼續留在該地或該院中服務的比率,達成均衡醫師人力分布的目的。
關鍵詞:執業地點、執業機構型態、專業生涯選擇、家庭醫學
Abstract
More recently, not only are physicians choices of practice locations getting unevenly distributed between urban and rural area, but their choices of practice institutions are also increasingly settled on large-scale hospitals located in urban area. The unevenly distribution of physician choices in terms of locations and institutions may have devastated effects upon accessibility of health resources. Therefore, it is important to examine the factors influencing physician career choices. This study aims to examine the relationships between physicians personal characteristics and their choices of practice locations and institutions. Personal characteristics examined included background, education experiences, as well as personal attitudes and value orientation.
The subjects of this study are family medicine specialty physicians who have graduated more than 8 years without receiving government scholarship. According to Association of Family Medicine in Taiwan, there are 743 physicians registered as general practice specialty. Questionnaires were mailed to all the physicians and 158 physicians (21.3%) responded to this survey. By excluding incomplete data, there were 130 profiles valid for analyses.
The logistic regression analysis revealed the relationship between personal characteristics and choices of location and institutions as followed:
(1) Physicians preferred to practicing in urban area were those who grew up and/or received residency training in urban area, graduated less then 10 years, as well as placed higher values on family needs.
(2) Physicians preferred sole or group practices were those who graduated more than 10 years and received residency training in regional hospitals.
(3) Physicians preferred to practicing in their hometown were those who placed higher value on ecological familiarity.
(4) Physicians preferred to remain in their residency training hospitals were those who graduated less than 10 years, placed higher value on professional growth and ecological familiarity.
(5) For choices of practice location, financial-related factors were the most important consideration, followed by factors related to educational advantages of their children.
(6) For choices of practice institution, work loading and hospitals’ reputation were the major consideration.
In conclusions, factors related to general practice physicians choices of location and institution include graduation years and residency experiences. Important implication can be derived from the powerful effect of residency experiences on physicians choices. It is suggested that alliances between hospitals in urban area and those in remote one should be encouraged so that residents trained in hospitals within the urban area will have the chance to work in an allied remote hospitals. Such residency experience may increase residents’ familiarity to the remote area and eventually influence their future choices of practice location and institution. Through such plausible arrangement, the volume of general practice physicians in underserved locations may increase to justify the uneven distribution of physicians resources.
Key words: practice location, practice institution,
professional career choices, family medicine
誌 謝………………………………………………………….…...….i
中文摘要………………………………………………………….…..….ii
英文摘要………………………………………………………….….….iv
目 錄………………………………………………………….….….vi
圖表目錄………………………………………………………….…....viii
第壹章 緒 論………………………….……………………..…..….1
第一節研究背景及動機………………………….…………..….1
第二節研究目的…………………………….………………..….5
第三節名詞釋義……………………………….……………..….6
第貳章 文獻探討…………………………………………….....……...9
第一節家庭醫學科之發展過程及醫師執業現況…………..…..9
第二節影響醫師人力分布之因素與改善建議…..……………15
第三節醫學生社會化與醫師專業生涯選擇之理論……….….21
第四節影響醫師執業地點選擇之因素……………….…….…25
第五節總結……………….………………………………..…...40
第參章研究設計與方法…………………………………….....……45
第一節研究架構…………………………………………..……45
第二節研究假說………………………………………….…….47
第三節研究對象……………….…………………………...…..48
第四節研究工具……………………….…………………….…49
第五節資料處理與分析……………………….………..…..….54
第肆章 研究結果……………………...…...……………...….……...64
第一節研究對象各調查變項之描述…….…………………….64
第二節影響醫師選擇執業地點及執業機構型態之
因素探討………………………………………………...76
第伍章討論與建議……………………...…...……………...…..…102
第一節研究結果之討論………………...……………...….….102
第二節研究限制……………………….……..………..….…..117
第三節結論………………….…………..…………………….119
第四節建議……………….………….…………………..……121
參考文獻………………………..…………………....…………….….126
附 錄…………….…….………………………....………………..132
附錄一 變項之操作型定義 ………………....………………..133
附錄二 研究問卷….……………………....……………….…..138
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